Animal surveies have shown that vascular smooth musculus hyperplasia and collagen biogenesis are reduced by estrogen disposal. In one clinical survey, postmenopausal estrogen usage was associated with important boundary line decreases in mensural common carotid arteria wall intimal median thickness even after commanding for other hazard factors such age, smoke, lipoids, etc. ( 50 ) .
In a subanalysis of the Asymptomatic Carotid Atherosclerosis Progression Study ( ACAPS ) , adult females who used ERT ( readying and dose non specified ) were assessed for carotid arteria wall intimal-medial thickness ( IMT ) by carotid echography. IMT, which is a marker for coronary artery disease, appeared to be retarded and to perchance change by reversal in adult females who took estrogen without having lipid-lowering therapy ( 51 ) .
Changes in Vascular Compliance and Blood Pressure
A freshly recognized marker for high blood pressure and coronary artery disease is reduced vascular conformity. The latter describes the status of the arterial wall that influences the relation between volume and force per unit area. In stiffer vass, a smaller volume alteration will do a greater force per unit area rise as compared to a usually compliant system. Vascular conformity is known to diminish with climacteric.
One direct step of vascular stiffness is the pulsatility index ( PI ) . This represents the electric resistance to blood flow downstream from the point of measuring. An addition in PI is closely correlated with the clip elapsed after the climacteric. Decreases in arterial wave form pulsatility index in the uterine and carotid arterias have been demonstrated in postmenopausal adult females after chronic estrogen replacing proposing an betterment in arterial conformity ( 52 ) . In another recent survey, patients were treated with estrogen and Lipo-Lutin for 1 years and a important lessening in PI was observed at 48 wk ( 53 ) . Arterial conformity is increased with gestation but returns to normal within 8 wk postpartum proposing that these alterations were non secondary to a alteration in vascular construction, but to a decrease in smooth musculus tone ( 56 ) .
Premenopausal adult females have lower systolic blood force per unit area than work forces of a similar age. After climacteric, nevertheless, systolic blood force per unit area tends to be higher than in age-matched males. One survey has besides shown that an addition in pulsatile constituents of blood force per unit area is associated with higher cardiovascular hazard in postmenopausal adult females ( 55 ) . The alterations in blood force per unit area with climacteric were explored in a survey of both premenopausal and postmenopausal adult females who were compared with age-matched work forces ( 56 ) . Using ultrasound/Doppler to mensurate vascular flow, the writers found that premenopausal adult females had lower systolic blood force per unit area in their peripheral arterias, but non in their cardinal ( i.e. , carotid ) arteria. Males had greater peripheral blood force per unit area that was attributed to elaboration of blood force per unit area from cardinal to peripheral arterias, which increased with organic structure tallness and decreased with arterial distensibility. In contrast, in postmenopausal adult females, arterial distensibility was similar to that of age-matched work forces and no longer compensated for smaller organic structure size, ensuing in a persistent increased defect of moving ridge contemplations in cardinal arterias, and greater peripheral blood force per unit area ( 56 ) .
In a related survey, 18 adult females with indispensable high blood pressure were followed for 3 year, during which clip they went through climacteric, to look into whether a natural lessening in sex endocrines in hypertensive adult females caused an addition in the stiffness of the aortal root ( 57 ) . The writers found that aortal root distensibility decreased significantly in adult females who had gone through menopause as compared with age-matched controls, proposing an of import function for worsening estrogen degrees in this procedure.
Changes in Cardiac Function
Estrogens affect hemodynamic parametric quantities through several different mechanisms. There is less grounds about the effects of worsening estrogen degrees with climacteric on hemodynamic map. In one survey, which followed adult females through the climacteric passage, no important alteration in echocardiographic measurings of end-diastolic and end-systolic dimensions were found after climacteric. However, important lessenings in remainder Doppler measurings of left ventricular contractility appeared increasingly over the old ages after climacteric in adult females non treated with endocrine replacing therapy ( 58 ) . These factors appeared to be modified with endocrine replacing therapy proposing a positive inotropic consequence of estrogen ( 59,60 ) .
METABOLIC CHANGES WITH MENOPAUSE
Changes in Lipid Metabolism
Several epidemiologic surveies have suggested additions in degrees of entire cholesterin, low-density lipoproteins and triglyceride rich lipoproteins associated with climacteric. He et Al ( 2012 ) have reported significantly higher prevalence of elevated entire cholesterin, triacylglycerols and LDL degrees in station menopausal Chinese adult females compared to premenopausal opposite numbers.
In general, HDL degrees are stable in the old ages after climacteric, although there may be a little decrease in HDL2 subfraction. Presumably, these alterations with climacteric are secondary to decrease in endogenous endocrines. This is surely supported by the good consequence of postmenopausal endocrine therapy on lipoprotein metamorphosis in postmenopausal adult females. Surveies suggest that estrogen usage is associated with lifts in high-density lipoprotein ( HDL ) cholesterin, particularly ( HDL ) cholesterin, particularly HDL2 ny every bit much as 20 % and decrease in low-density lipoprotein ( LDL ) cholesterin by every bit much as 19 %
An elevated Lp ( a ) degree is independently associated with the development of CAD in adult females ( 64 ) every bit good as work forces. Lp ( a ) is a modified signifier of LDL to which an apolipoprotein is attached. Its familial construction is similar to plasminogen and, therefore it interferes with the binding of plasminogen to sites of cells and molecules. Degrees of Lp ( a ) are chiefly determined by gentic and, as such, there are no disconnected alterations in Lp ( a ) with climacteric. However, estrogen theraphy appears to cut down Lp ( a ) degrees. An elevated plasmahomocysteine degree is an independent hazard factor for CAD particularly premature coronary artery disease. Degrees are known to increase in both genders with age. After climacteric, fasting homocysteine degrees may increase or remain the same ( 65 ) . Therefore, the impact of worsening estrogen degrees on homocysteine degrees is ill-defined.
In carnal surveies, estrogen appears to interfere with cholesterin deposition in the arterial wall ( 66 ) and in laboratory surveies to cut down arterial smooth musculus cells proliferation ( 29 ) . Oxidative alteration of LDL cholesterin may be an of import measure in atherogenesis. In carnal surveies, the oxidised signifier of LDL appears to be more effectual than inactive LDL in impairing endothelium-dependent vasodilation. One recent survey suggests that endothelium mediated vasodilation is improved with lipid take downing drugs in patients with elevated cholesterin peculiarly if the lipid lowering therapy lowers rates of LDL oxidization ( 67 ) . In vitro surveies suggest that 17-i?? estradiol appears to suppress LDL oxidization and cut down cholesterin ester formation ( 68 ) . In one survey, 17-i?? estradiol disposal significantly reduced the oxidization of LDL cholesterin from postmenopausal adult females ( 69 ) .
Changes in Cloting
Certain styptic variables change with climacteric with a possible impact on both thrombosis and fibrinolysis. After climacteric, factor I degrees addition as do degrees of factor VII and antithrombin III. Higher degrees of PAI-1 an adversary of fibrinolysis in worlds, have been noted in postmenopausal adult females in the Framingham Offspring Study ( 71 ) . Surveies of HRT in postmenopausal adult females suggest a lessening in factor I ( 72 ) , and a lessening in PAI-1 ( 73 ) . Animal surveies besides suggest that estrogen inhibits platelet collection.
Symptoms of Vasomotor Instability
Symptoms of vasomotor instability include palpitations and, in a little per centum of adult females, symptoms of chest force per unit area. Although they occur most frequently in concurrence with hot flashes, an addition in palpitations can be seen in the absence of other symptoms. The badness of these cardiac symptoms appears to be related to the badness of the hot flashes ( 74 ) . Vasomotor symptoms and associated cardiac symptoms are more terrible in patients who experience a sudden bead in their estrogen degree ( e.g. , surgical climacteric ) . In one longitudinal survey of 200 perimenopausal adult females from Scandinavia, palpitations figured conspicuously in the symptomatology in association with other vasomotor ailments ( 75 ) . In another study of 501 adult females, 1220 % of those who were postmenopausal celebrated force per unit area in thorax and 3647 % noted a alteration in bosom rate in association with their hot flashes ( 76 ) .
Effectss on Glucose Metabolism
Estrogens have been known to impact glucose metamorphosis which is apparent by presence of estrogen receptors in pancreatic islets. Tiano and co-workers ( 8 ) examined the function of estrogen in pancreatic ? cells based on their observations that in many rodent theoretical accounts of diabetes and dysregulated glucose homeostasis, the females remained comparatively protected with regard to the pancreatic ? cell map. Tiano et Al. ( 8 ) posited that ovarian endocrines may supply protection
against pancreatic ? cell abnormalcies. These writers focused on what happens in males when supplemented with estrogens. In the first series of experiments,
the writers found that handling male Zucker diabetic fatso rats with 17 ? estradiol suppressed the synthesis and accretion of fatty acids and protected against pancreatic ? cell failure. Furthermore, they demonstrated that the antilipogenic actions of estrogens were replicated with pharmacological activation of ER ? . The writers looked at a host of glucose parametric quantities and in every instance found that estrogenic supplementation reversed the effects in the dysregulated glucose homeostasis in diabetic fatty rats. In add-on, omission of ER ? from the pancreas prevented the decrease of lipid synthesis by estrogens and increased islet lipid accretion and ? cell disfunction in response to a high-fat diet. The writers demonstrated that estrogenic activation inhibited ? cell lipid synthesis by stamp downing the look of fatty acerb synthase through a non classical ( NERKI ) tract that was dependent on activated ( pSTAT3 ) STAT3. Finally, they demonstrated that omission of STAT3 from the pancreas curtailed ER ? mediated suppression of lipid synthesis.
Anemia has been emerging as potent hazard multiplier of mortality hazard in middle-age population. Earlier considered to be simply a disease marker, it is now envisaged as holding profound deductions as a comorbid factor for other unwellnesss while presenting a serious wellness hazard on its ain. Anemic patients have a shorter endurance than their nonanemic, age-matched counterparts4 and anaemia is besides an independent hazard factor for mortality in bosom disease5, cancer6, nephritic disease7 and HIV infection8
The prevalence of anaemia harmonizing to NHANES III ( 1988-1994 ) , in US adult females of age-group 50-64 old ages, was reported to be 6.8 % as compared to 4.4 % in work forces and 8.5 % in 65-74 twelvemonth old adult females and farther 10.3 % in 75-84 twelvemonth old females. However, the prevalence of anaemia continues to be higher in pre-menopausal adult females than in those sing climacteric ( 11 % in pre-menopausal versus 19 % in perimenopausal adult females in US, 2002 ) 9. Prevalence in Indian middle-aged adult females needs to be studied, due deficiency of informations in this respect and particularly in position of outgrowth of anaemia as an independent hazard factor for bosom disease, which affects adult females in middle-age.
Fig 2.8 Cascade of Metabolic Events due to Estrogen Deficiency
Degree centigrades: UsersPublicDocumentsRESEARCH WORKPhDReviewImagesCascade of Metabolic Events due to Estrogen Deficiency.jpg
Overweight and Obesity
World Health Organization ( WHO ) defines overweight as holding a Body Mass Index ( BMI ) & A ; gt ; 25kg/m2 and fleshiness as BMI & A ; gt ; 30kg/m2. There are about 350 million corpulent people and over 1 billion fleshy people in the universe. Over all about 2.5 1000000s deceases are attributed to overweight/obesity worldwide. Prevalence of fleshiness in India, as estimated by the National Family Health Survey 3 10 in rural and urban adult females, was reported to be highest in age-group of 40-49 old ages: 6.4 % as compared to merely 2.3 % in males in the same age group ; followed by 3.9 % in 30-39 twelvemonth age group ( work forces 1.8 % ) and 1.2 % in 20-29 twelvemonth age group ( work forces 0.7 % ) . Similar tendencies were reported in instance of fleshy prevalence: highest prevalence was in adult females in 40-49year age group ( 23.7 % ) compared to 15.2 % in work forces of same age group ; followed by 17.4 % in 30-39 twelvemonth age group compared to 13 % in work forces and 8.2 % in 20-29 old ages age group compared to 6.5 % in work forces. Therefore, fleshy and fleshiness is prevailing highest in adult females at and around menopausal age.
WHO ( 2000 ) estimates the planetary prevalence of Diabetes to be 171 million and India contributes 31.7 million instances. The National Health Interview Survey in US ( 2003 ) mapped diabetes prevalence and found a systematic addition in prevalence with age in both the sexes: 2.8 % in 35-39 old ages, 6.5 % in 45-49 old ages, 11.7 % in 55-59 old ages and 15.1 % in 65 old ages and supra. In India, National Urban Diabetes Survey 11 reported the national prevalence of diabetes ( FBS & A ; gt ; 125 ) to be 8.5 % in adult females aged 34-35 old ages, which increased to 19.7 % in 45-49 old ages and 28.7 % in 54-59 old ages. Jaipur Heart Watch 3 12 estimated prevalence in Punjabi Bhatia community in urban every bit good as rural countries to be 1.6 % in adult females aged 30-39 old ages, 12.2 % in 40-49 old ages and 27.3 % in 50-59 old ages and 37.8 % in 60 old ages and more. Thus a tendency of a sudden rise in prevalence of diabetes after 40 old ages can be noticed in Indian adult females.
High blood pressure
High blood pressure, defined as Systolic Blood Pressure ( BP ) higher than 120mmHg and/or Diastolic BP higher than 80mmHg, is the extremely prevailing menace to cardio-vascular wellness. Globally, 26.1 % of adult females have high blood pressure 13. The Jaipur bosom Watch 3 12 reported the prevalence of high blood pressure in urban adult females to be 29 % in 30-39 twelvemonth age-group, which rose to 67.3 % in 40-49 old ages, 72.7 % in 50-59 old ages and making extremum at 91.2 % in 60 old ages and above age group.
Dyslipidemia is defined as entire cholesterin higher than 200mg/dl, LDL-C & A ; gt ; 100mg/dl, Triacylglycerols & A ; gt ; 150mg/dl. Dyslipidemia additions quickly in menopausal age. Percent prevalence of hypercholesteremia ( TC & A ; gt ; 200mg/dl ) in US adult females, as reported by National Health and Nutrition Examination Survey 14 was 16.2 in 35-39 old ages age group, which increased to 25.3 % in 45-49 old ages and 31.1 % in 55-59 old ages. In a survey done in Jaipur 12, the prevalence of high sum cholesterin ( TC & A ; gt ; 200mg/dl ) in urban and rural adult females was reported to be 22 % in 30-39 old ages, 34 % in 40-59 old ages and 42 % in 60years and supra.
Subclinical Hypothyroidism ( SCH ) , defined as TSH & A ; gt ; 4mU/l in presence of normal free T4 ( FT4 ) [ 0.9 to 1.9 ng/dL ] , is emerging as a yet another co-morbid factor in the household of hazard factors of chronic diseases. While clinical Hypothyroidism has been known to adversely impact cardiovascular wellness, SCH is besides argued to be associated with high blood pressure 15, responsible for 19.3mg/dl of entire cholesterin in in-between elderly adult females and its prevalence tallies every bit high as 7.6 % in in-between elderly adult females belonging to Netherlands, as compared to merely 1.9 % in work forces of the same age group 16. Harmonizing to the Rotterdam prospective cohort survey 17, the prevalence ( in center aged adult females ) was even higher: 10.8 % .
WHEATGRASS – THE WONDER HERB OF AYURVEDA
Wheatgrass, enormously popular in Indian traditional mending systems, has been found to be effectual in intervention of GI upsets ( Ben-Arye et al 2002 ) . It is a popular traditional belief that eating wheat-grass confers the benefits of devouring big sums of veggies in a twenty-four hours. The composing of wheat-grass histories for this impression: 3.5g of wheat-grass itself has 15mg chlorophyll, 1g dietetic fiber, 1mg Lutein and 29mcg Lycopene, 2-8 % RDA of all indispensable amino acids. Wheatgrass has been shown to exhibit first-class antioxidant belongingss. Wheatgrass infusions have been found to suppress significantly ascorbate-Fe2+ induced lipid peroxidation in rat liver chondriosome and its free extremist scavenging ability is reported to be higher than those of many natural infusions or veggies ( Kulkarni et al 2006 ) .
Wheatgrass is found to be rich in all major three categories of bioactive compounds: Phytosterols, Viscous Polysaccharides and Polyphenols. Phytosterols, viz. beta-sitosterol, campesterol, and stigmasterol were found in hexane infusions of wheat-grass, with beta-sitosterol accounting to 74 % of the entire phytosterols in the infusion, which ranged from 834-1206 mg/kg ( Dunford, Irmak and Jonnala 2009, Dunford and Edwards 2010 ) . Polyphenol tests revealed the presence of flavonoids, triterpenoids, anthranol, alkaloids, tannic acids, saponins and steroid alcohols in fresh grass juice ( Kothari et al 2011 ) .Aqueous infusions of wheat-grass were found to incorporate gums and mucilages besides, which belong to the household of syrupy polyoses ( Shirude 2011 ) .
It has been found that wheat-grass has a lysine arginine ratio of 0.7, considered to be low compared to animal protein, with the value for casein being 1.2 ; and besides a low methionine content of 15mg per 3.5g of wheat-grass, which is terribly low compared to 86mg of 100ml cow ‘s milk or other proteins of carnal beginning. A low lysine-arginine ratio and low methionine content have found to exercise hypocholesterolemic effects ( Kritchevsky 1979 ) .The underlying mechanisms seem to be reduced soaking up of cholesterin, addition in glucagon secernment and suppression of insulin production ( Sanchez 1991 ) . The other mechanism can be stamp downing the HMG CoA reductase and 7-?-hydroxylase activities through modulating hepatic glutathione concentrations ( Potter and Kies 1990 ) .
Consequences from a recent mouse theoretical account survey ( Kothari et al 2011 ) on wheat-grass were similar to establish in this research, wherein wheat-grass juicewas administered at 5 mL/kg and 10 mL/kg in hypercholesteremia induced Wistarrats for a period of 14 yearss. The supplementation resulted in dose dependent important ( p & A ; lt ; 0.05 ) diminution in TC, TAG, LDL and VLDL levels.The research workers besides looked at the faecal cholesterin elimination which was significantly enhanced ( P & A ; lt ; 0.05 ) upon wheat-grass supplementation.
Another survey in coney theoretical account ( Das, Hakim and Mittal 2012 ) evaluated the consequence of ethanol infusion of wheat-grass hyperlipidemic every bit good as normal animate beings. The experimental animate beings were fed 500mg/kg/day of wheat-grass infusion orally for a period of 12 hebdomads, after which the writers found a important ( p & A ; lt ; 0.05 ) diminution in the serum TG, TAG, LDL and MDA degrees of the animate beings in both the normal and hypercholesterolemic groups. Interestingly, the HDL cholesterin had increased in the normal group but decreased in the hypercholesterolemic group. In the present survey excessively, the auxiliary group, all of whom were hypercholesterolemics, saw a diminution in the HDL degrees.
Experiments on the glycemic and lipemic index of wheat-grass incorporating formulas ( Iyer, Sharma, Dhruv and Mani 2009 ) have reported that incorporation of wheat-grass into formulas reduced the glycemic index and the TAG degree response of the formulas as compared to without add-on of wheat-grass.
The anti-inflammatoryeffect of wheat-grass can be attributed partially to the presence of beta sitosterol which has been found to exercise protective effects against endothelial redness. Specifically, beta-sitosterol has been found to forestall inflammatory alterations by stamp downing vascular adhesion molecule 1 and intracellular adhesion molecule 1 look in Tumor Necrosis Factor alpha ( TNF-? ) -stimulated human aortal endothelial cellsin add-on to suppressing binding of U937 cells to TNF-?-stimulated human aortal endothelial cells. It besides attenuates the phosphorylation of atomic factor-kappa B ( Loizou 2010 ) .
wheat-grass on oxidative emphasis can be attributed to its high antioxidant activity as reported by Kulkarni et Al ( 2006 ) . Specifically, the writers found that the ethanol infusions of wheat-grass were found to hold higher phenoplast and flavonoid content than the aqueous infusions. The writers besides reported the antioxidant activity in footings of FRAP values, which were found to be 0.463 and 0.573 mmol of ascorbic acid and Trolox equivalents/100 g fresh wheat-grass for aqueous and ethanol infusions, severally. These infusions were besides found to suppress significantly ascorbate-Fe2+ induced lipid peroxidation in rat liver chondriosome. The writers besides reported the ORAC values of aqueous and ethanol infusions ( 39.9 and 48.2 severally ) being higher than those reported for many natural infusions or veggies.
The different degree of impregnation of hazard factors in adult females, together with their interaction with female endocrines, plays an of import function in the development of cardiovascular disease ; and given that in-between adult females form a ample portion of the Indian human ecology, the wellness disbursals incurred towards chronic disease relief by this immense section of the population would be a cause of grave concern for the interest holders. However, to chalk out conclusive determinations on the intercessions and the extent of coverage, comprehensive surveies crossing the complete image of the metabolic and cardio-vascular hazard factors across a important portion of the Indian population is a pre-requisite.
But in this respect, most of the surveies are on the western population and informations in the regional context is missing. Furthermore, the reappraisal suggests that Indian surveies even though documented, are scattered and do non supply an across-the-board portrayal of the state of affairs.
In this context, a broad scope of nutraceuticals and functional nutrients have been tried as has been reviewed, but discreetly designed tests on the Indian cultural population groups are scarce and fail to supply any conclusive grounds. On the other manus, the benefits of the admiration herb of Ayurveda- Wheatgrass has been scientifically shown to possess a assortment of vitamins, indispensable minerals, phytochemicals, antioxidants and other bioactive molecules which render wheat-grass to be a promising natural substance to be considered for cut downing serum cholesterin and lipid peroxidation due to oxidative emphasis. Therefore, a scientifically designed test in this respect is justified to divide myths from facts and to measure whether wheat-grass can be promoted as a functional nutrient for the direction of lipemia.
Therefore a demand was felt to set about a set of surveies which would turn to all these questions and the inside informations of the research inquiries addressed therein are described in the subsequent subdivision.